Development of a psychometrically valid and reliable measure of primary care providers' willingness to engage with value based payments and innovations in care coordination

Background: Most approaches to healthcare reform envision an enhanced role for primary care providers, supported by innovative payment methodology and improved resources. However, there are currently no instruments to measure providers' ability and willingness to work with existing tools provided by payers, such as Accountable Care Organizations (ACO). In this study, we develop and psychometrically test a new instrument to measure provider engagement with ACOs.

Methodology/ approach: The instrument was developed based on a self-efficacy theory of the adoption of innovations. We hypothesized two underlying constructs: Ease of Use ("Ease") and Perceived Usefulness ("Usefulness"). Constructs were tested using confirmatory factor analysis. Reliability was assessed with Cronbach's Alpha and convergent and divergent validity. Survey subjects were Primary Care Providers engaged with an ACO.

Results: Eigenvalue and scree plots indicated the hypothesized two factor model was appropriate. Four questions failed to load onto a single factor - three from Ease and one from Usefulness. Both scales have outstanding reliability, with an Alpha of 0.951 for Usefulness and 0.831 for Ease. For validity, the results are consistent with our prior hypotheses for convergent and divergent validity.

Conclusions: The new instrument is a valid and reliable measure of providers' ability to work with and gain value from ACO participation.

Practice implications: The success of any health care reform will be highly dependent on primary care providers' willingness and ability to engage with payers. This instrument provides a new tool to measure the value and difficulty of that engagement by primary care providers.